Dissertations / Theses on the topic 'Universal cage'

Prevalence of missed health care by life course stage is examined with a critique of the measure of missed care. Canadians reporting missed care has increased from 4.2% in 1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2. What are the relationships among life course stages, social support, predisposing, enabling and need factors to the reporting of missed care? 3. What is the role that life course stages play in the relationships among social support, predisposing, enabling, and need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What reasons are provide for missing care?; and 6. Who accesses primary care and what is the relationship to reporting missed care? Methods: Analysis was done using the Canadian Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore the relationships among variables of interest predicting missed care. Results: Young adults (18-30) are more likely to report missed care compared to other age groups and are least likely to have a regular doctor. Social support is most significantly protective against missed care for young adults. Weak sense of belonging to a local community and lower income are stronger predictors of missed care for young adults. Young adults differ from others in the reasons they report for missed care (i.e., more likely to report cost as a barrier). Discussion: It's not clear if the difference between young adults and other life course stages is in actual missed care or expectations of primary care. Yet, the literature on emerging adulthood invites curiosity about how delayed adulthood leaves them in less stable, financially insecure, socially and institutionally isolated situations that have subsequent consequences for primary care access. Changes in models of primary care have led to a decline in comprehensive care and more drop-in clinics; while, not having a regular doctor is associated with missed care. If patterns of inadequate primary care access established in young adulthood are perpetuated in later life, this may foretell undesirable consequences for the health of Canadians. A new model for measuring unmet health care needs is proposed.<br>Graduate and Postdoctoral Studies<br>Graduate

To achieve effective access to health care, countries have adopted various policies to improve the populations' legitimate right to obtain health care when needed. Social health insurance has been proposed by the WHO as a means to securing sustainable access to health care particularly for developing countries. As one of the developing countries, Sudan launched SHI in 1994; however, population coverage still does not exceed 28.7% of the total population. Given the complexities of access to health care, the issue of achieving universal access by the adoption of SHI is faced with various challenges. Recognising the factors that influence an individual's decision to access health care ultimately adds to the success of the policy intervention to meet the stated goals. In addition, understanding and recognising the households' perspectives and motives to affiliate with SHI is critical to the success of the devised policy initiative. Therefore, this thesis examines the determinants of both access to health care and enrolment in social health insurance in Sudan. It also examines the implication of the adoption of social health insurance as a means to improving the population's access to health care. To achieve the stated objectives, the thesis adopted a quantitative cross-sectional study design involving a household survey in Kassala State in Sudan. The household survey (n=560) collected information from 280 voluntary insured households as well as 280 uninsured households living in rural and urban areas of Kassala State. The study confirms that both access to health care and voluntary enrolment in SHI in Sudan are influenced by factors embedded in the Andersen and Penchansky models of access to health care. These factors include the head of the household's; age, place of residence, gender, health status, the number of family members, perception about the waiting time to see the doctor, perception about the staff treatment, the level of knowledge about SHI and the monthly income. The study confirms that SHI does not act directly to improve utilization of health care; instead, its effect is mediated by other factors especially income level. Thus, access to health care is not merely the function of the health insurance status of the population; however, together with empowering the household's income level, improving the supply side of the health delivery system and reducing the gender inequality SHI is more likely to improve the population's access to health care. In addition, the study proves that those who are able to pay the health insurance premium and joined the scheme, are either looking for additional value for money (e.g. getting health services at a cheap price) or escaping an escalating cost of health care resulting from personal costly health status (e.g. chronic illness). Thus, the success of improving voluntary uptake of SHI depends on adding convincing value for money, raising the people's awareness about the scheme especially female households, targeting rural residence, especially those with large family size, and otherwise adopting a compulsory enrolment policy. The thesis contributed to knowledge through the development of a single theoretical framework encompassing both the health seeking behaviour and the adequacy of the health delivery system. The theoretical framework not only studied access to healthcare but also the factors that influence enrolment in health insurance. The new conceptual framework and the thesis's policy implications are applicable to developing countries that adopt SHI and express socioeconomic characteristic and problems resembling that of Sudan. It is also worth mentioning it is the first study to evaluate the impact of Sudan SHI in terms of population access to health care.

Bakgrunn: Bygninger med universell utforming vil kunne gi økt deltakelse og aktivitet for flere. Mål: Studiet har målsetting om å vise hvordan implementering av universell utforming kan foregå i en norsk kommune og vise til hvilke implementeringskriterier som er viktig med hensyn til å oppnå universell utforming. Metode: Case study er brukt som forskningsmetode. Studiet består av fire case; to skole- og to barnehagebygg. Visning av bilder ble brukt som metode for å illustrere universell utforming og gi økt kunnskap om temaet til berørte parter. Bygningene ble kartlagt med hensyn til hvorvidt bygningsmassen tilfredstiller ytelser nedfelt i veileding til tekniske forskrifter. Videre vil utfylte kartleggingsverktøy beskrive hva som bør gjøres av tiltak med hensyn til universell utforming.Ett år etter kartleggingsarbeidet intervjuet vi seks sentrale informanter; kommunalsjef, leder av eiendomsavdelingen, politiker, avdelingsleder for barnehagene samt leder for hver av de to barnehagene. Følgende spørsmål ble stilt: Hvilke politiske beslutninger er tatt? Hvilken forståelse og kunnskap har informanten om universell utforming?  Hvordan har planprosessen forløpt i kommunen? Økonomiske betraktninger? Hva er viktig for implementering av universell utforming? Resultat: Funn fra kartleggingsarbeidet viser mangelfull universell utforming vedrørende fremkommelighet, orienterbarhet og inneklima. Ett år etter kartleggingsarbeid ble det gjennomført intervju av seks sentrale informanter. Studiet identifiserte implementerings-kriterier for å oppnå universell utforming. Det er nødvendig med politisk og administrativ forankring, felles forståelse og samhandling mellom helse – og teknisk sektor, samarbeid med brukerorganisasjoner, plassering av et pådriveransvar for universell utforming og økonomiske ressurser avsatt til arbeidet for å oppnå implementering av universell utforming. Konklusjon: kartleggingsarbeid og bruk av implementeringskriterier er viktig for å oppnå universell utforming. Det er viktig med innspill vedrørende universell utforming tidlig i planprosesser. Med fordel kan videre forskning vise sammenheng mellom universell utforming og opplevelse av helse.<br>Background: Buildings that implement universal design provide increased participation and activity levels for many people. Purpose: This study aimed to show how a Norwegian community could use universal design for a planned rehabilitation of school and pre-school buildings. We sought to describe the steps necessary to achieve universal design. Methods: Our case study formed the basis of our investigation regarding the potential of universal design in school buildings. To raise awareness in study participants, we showed them photographs illustrating universal design. We also mapped the buildings according to their fulfillment of the “Guidelines to technical regulations” provided by both the construction plan and building legislation. One year following the mapping exercise, we surveyed six central participants; executive officer, manager of the property department, local politicians, managers and department heads of 2 childcare units. The following questions were posed: Which political decisions have been taken? What does the participant know about universal design? Describe planning processes in the local authority? What economical considerations have been taken? Describe the important factors necessary to implement universal design? Results: Mapping revealed insufficient design regarding mobility, adaptation ability, and indoor climate. Our study identified criteria that are essential to achieving universal design, including increased knowledge and understanding of universal design; political and administrative funding of the work; common understanding and interaction between the health sector, user organizations, and the technical sector; accountability; and economic recourses. Interviews indicated that study reports aided the municipality in laying groundwork for further rehabilitation of the buildings. Conclusions: While reports and implementation criteria contribute importantly to achieving universal design, it is important to use such information and guidelines early in the planning process. Further research is required to determine a possible connection between universal design and perception of health.<br><p>ISBN 978-91-85721-65-8</p>

A universal human dignity, conceived as an inherent and inalienable value or worth in all human beings, which ought to be recognised, respected and protected by others, has become one of the most prominent and widely promoted interpretations of human dignity, especially in international human rights law. Yet, it is also one of the most difficult interpretations of human dignity to justify and ground. The fundamental problem rests on how one can justify bestowing an equal high worth to all human lives, whilst also attributing to all human life a worth that is superior to all non-human animal life. To avoid the speciesist charge it seems necessary to provide further reasons, over and above species membership, for why all humans have a unique worth and dignity. However, intrinsic capacities, such as autonomy, intelligence or language use, are too demanding for many humans (including foetuses or the severely cognitively disabled) to meet the required minimum standard, whilst also being obtainable by some non-human animals, regardless of where the level is set. This thesis offers a solution to this problem by turning instead to the significance of the relational ties between individuals or groups that transcend individual capacities and abilities, and consequently does not require that all individuals in the group need meet the minimum required capacity for full moral status. Rather, it is argued that a universal human dignity could be grounded in our social nature, the interconnectedness and interdependence of human life and the morally considerable relationships that can and do arise from it, especially in regards to our shared vulnerability and dependence, and our ability to engage in caring relationships. Care represents the antithesis to the dehumanizing effects of humiliation, and other degrading and dehumanizing acts, and as a relational concept, human dignity is often best realised through our caring relationships. The way that individuals and groups treat each other has a fundamental role in determining both an individual’s sense of self-worth and well-being, as well as their perceived public value and worth. Thus, whilst species membership is not in itself morally fundamental or basic, it often shapes the nature of our social and moral relations. These relational ties between humans, it is argued, distinguish us most clearly from other non-human animals and accord human relationships a special moral significance or dignity.

In 2001, Thailand introduced the Universal Coverage of Health Care Policy (UC) very rapidly after the new government came to power. The policy aims to entitle all citizens to health care and includes health system reforms to achieve equity, efficiency, and accountability. The overall question this thesis asks is how did this policy come about, and how likely is it that the policy will achieve its goals? Literature suggests that understanding the policy process is as important as assessing the content of particular policies when judging policy outcomes. By using an analytical framework to explore four elements: context, actors, process, and content, this thesis aims to generate general understanding of the UC policy process, and to use this analysis to assess implementation. It starts by addressing how and why universal coverage, which had long been discussed in Thailand, got on to the policy agenda in 2001, and then explores how the policy was formulated nationally. It goes on to look at implementation in one province, examining the inter-relationships between provincial, district and community facilities. Data were gathered from key informant interviews, document and media analysis, and group discussion with villagers. The analysis suggests that Thailand's democratization, created new actors in health policymaking processes which had long been under control of bureaucrats and professionals. The 1997 Constitution encouraged a more pluralistic political system. Universal access to health was advocated by a group of non-government organizations who pushed to get UC through legislation and announced their campaign a few months before the 2001 election. NGO interest was paralleled by a political party campaign, announced in 2000 by the Thai-Rak Thai Party, and implemented as UC when the Party came to power. UC was picked up because it was seen as legitimate, feasible under the existing infrastructure and government budget, and also congruent with the reform intention of the political party. Once it became the government in 2001, an important factor in early policy formulation was the extent to which national research provided evidence to support the policy. The research community was tightly-knit and concentrated in medical-related professions. One member of this policy community played an important role as a policy entrepreneur. This policy community continued to support evidence for debates in policy-making during both policy formulation and implementation. The implementation process was a top-down process; however, there were some spaces for street level bureaucrats to adapt decisions to fit their context. Implementation started through the extension of insurance coverage in four phases under the execution of the Ministry of Public Health. Private providers were only minimally involved in these formulation and implementation phases. The UC policy in 2001-2 was characterised by clear policy goals, limited participation, strong institutional capacity, and very rapid implementation - all factors which anticipated success of the policy. However, the complex technical features of the policy and the big change in system reform were a brake on success. One of the implementation problems was the mobilization of human resources, especially where bureaucrats were resistant to change. It seems that the implementation of the UC policy in Thailand reflected both managerial as well as political problems. Given the findings of this study, policy monitoring should pay attention to political as well as technical assessment.

Childhood cancers are a rare group of diseases for which despite relatively high cure rates for some cancers when detected early, survival rates remain low in many low and middle-income countries (LMICs) compared to high income countries. This is in part due to multiple socioeconomic and health system related factors impeding access to timely diagnosis and treatment. An essential component of Universal Health Coverage (UHC) is improving ‘access to health services’ and ensuring all people have equitable access - including children with cancer, particularly since health systems strengthening for childhood cancers is likely to improve the health system for other disease conditions as well. For UHC to include a disease like childhood cancer, an understanding of the barriers to accessing childhood cancer care at the individual and health system levels is necessary. India manages childhood cancers through a fragmented health system while simultaneously embarking upon a commitment towards achieving UHC. While research has been undertaken on childhood cancer care in India, there are still gaps in research regarding specific health system and individual barriers to cancer diagnosis and treatment for children. Therefore, the overarching aims of this thesis were to identify and understand barriers in accessing childhood cancer care and to explore how these findings might assist in the quest to achieve UHC. This thesis did not aim to prescribe any single approach or package for the inclusion of childhood cancers in UHC, nor does it evaluate policy-making strategies or financial measures to support this. Rather, this thesis aims to present evidence of access to care issues which should be considered when developing actionable UHC policy agendas for addressing childhood cancer care in India. The thesis addresses its aims through a series of interrelated qualitative and quantitative methodological studies which highlight delays to diagnosis and treatment as well as health system and individual related barriers affecting access to care. It concludes with examining the current strategies for childhood cancer care in India and recommendations for future advancements.

A phenomenological-grounded theory methodology was utilized to explore the transformational healing journeys of five Caucasian men in recovery from pervasive shame in their lives. An overview of several western approaches to treating shame are included, as well as two predominant Universal Developmental theories of shame and its link to the resolution of narcissism. During the thematic analysis of the interviews, thirteen themes were derived, which constituted a chronological depiction of the story of shame, as it unfolded in the lives of the participants. Additionally, an in-depth look at the families of origin, and the beginnings of shame in the participants’ lives is presented, as well as a picture of how their lives are now, after recovery from their shame. Implications for counseling were addressed.<br>ix, 196 leaves ; 29 cm

The public sector of all western developed countries has become increasingly involved in financing health care during the past century. Today, thirteen OECD countries have passed landmark legislative reforms that call for compulsory prepayment and universal entitlement to comprehensive services, while most of the others achieve similar coverage through a mixture of public and private voluntary arrangements. This study carried out a detailed analysis of why, how and to what effect governments became involved in health care financing in eight of these countries. During the early phase of this evolution, reliance on direct out-of-pocket payment and an unregulated market mechanism for the financing, production and delivery of health care led to many unsatisfactory outcomes in the allocation of scarce resources, redistribution of the financial burden of illness and stabilisation of health care activities. This forced the state to intervene through regulations, subsidies and direct provision of services. Expansion in prepayment of health care gradually occurred through private insurance, social insurance and general revenues in response to different socio-economic, political and bureaucratic forces. Although improving health may have been the ultimate goal, offering universal access to affordable health care was the way the countries examined achieved this objective. Universal comprehensive coverage was associated with a decade of stable public expenditure on health care compared with GDP, total government expenditure and government consumption expenditure. There were no disproportionate increases in health care expenditure or displacement of public funds away from social programmes that depended on cash transfer payments. Nor do the countries that offer such social protection have higher public debt or poorer economic performance compared with the rest of the OECD. Measures of health status are unfortunately still not sufficiently developed or standardised to permit a detailed analysis of this aspect of outcome through cross-national comparisons. Furthermore, the countries examined may be more vulnerable to political backlash because of the high visibility of their government involvement in health care financing.

In my thesis I focus on the economic impacts of public policy. I apply micro-econometric techniques to develop a better understanding of whether maternity leave benefi ts do a ffect women's fertility decisions and whether the development of children can be a ffected by universal child care programmes. In the second chapter, I assess the eff ects of changes in financial incentives on fertility arising from a reform in parental leave benefi ts, which increased the financial incentives to have a child for higher-earning women considerably. I find positive statistically significant effects on fertility. My findings suggest that earnings dependent parental bene fits, which compensate women for their opportunity cost of childbearing accordingly, might be a successful means to increase the fertility rate of high-skilled and higher-earning women and to reduce the disparity in fertility rates with respect to mothers' education and earnings. In the third chapter, I study the e ffeect of a German universal child care programme (aimed at 3- to 6-year-olds) on school readiness indicators. I draw on unique administrative data for the entire population of children who are about to start school in one large region. I finnd that longer public child care attendance robustly improves overall school readiness for children of immigrant ancestry. The finndings suggest that universal child care programmes help to narrow the achievement gap between children of immigrant and native ancestry. In the fourth chapter, I estimate marginal returns to child care attendance. I find substantial heterogeneity in the returns to early child care attendance with respect to variables observed and unobserved (by the researcher). Children who are least likely to attend child care early benefi t the most from early child care attendance. The findings imply that alternative policies, such as extending the availability of child care further or adjusting the admission criteria through quotas, would potentially have high returns.

This thesis is a critique and proposed reform of the decision-making process under the European Patent Convention 1973, Article 53(a) as it relates to morality. It postulates that the manner in which the morality bar is currently managed is inappropriate as it relies on patent officials to make the initial decision as to whether the patent application is morally permissible or not. In a pluralistic world, morality is understood differently by a wide variety of people but this is not currently being acknowledged within the patent system. Whilst there is an option to bring opposition proceedings to challenge patent grants, this onus is considerable on the challenger and any debate is then played out by a very small sector of highly specialised experts, often with very differing views on morality. This thesis seeks to broaden the decision-making process to reflect society's pluralism. Officials, it will be argued, should instead of trying to decide what constitutes morality in a realm of such importance for humanity as a whole, administer a system which facilitates public participation and a vote. This will be based on existing models of widespread public deliberation and participation, albeit not ones that currently operate in (or near) the patent world. At present, criticisms in the legal literature tend to suggest more deliberation in the patent field and more participation is recommended in science literature but the logistics are unexplored and will be brought together in this work, making an original contribution to knowledge. In order to achieve its aim, the thesis employs a pluralistic methodology which includes doctrinal, socio-legal and interdisciplinary facets which will enable the construction of a model for reform of the patent system in the domain of morality. This will come from outside of traditional legal mechanisms such as legislative, judicial or patent office reform solutions, as a far-reaching paradigm is envisaged. The claim to originality lies in the extraction of principles from deliberative and participatory models of democracy and their application to the decision-making process in morally controversial biotechnological patents.

There is an increase in HIV/AIDS and other blood borne diseases. Health care workers are often exposed to blood and body fluids and thus prone to blood borne infections. Preventative measures can be taken to prevent health workers from contracting these diseases. However, health care workers need to stringently apply these measures. Universal precautions against blood borne infections include diligent hygiene practices, such as hand washing and drying, appropriate handling and disposal of sharp objects, prevention of needle stick or sharp injuries, appropriate handling of patient care equipment and soiled linen, environmental cleaning and spills management, appropriate handling of waste as well as protective clothing such as gloves, gowns, aprons, masks and protective eyewear. This study is aimed at investigating compliance with universal precautions in operating theatres in Northern KwaZulu–Natal as well as perceptions of registered nurses working in these operating theatres regarding factors influencing compliance in order to contribute to measures to limit the risk of infection to patients and health care workers. A sequential explanatory design, mixed–method (quantitative and qualitative) was used to explore the use of universal precautions in operating theatres in the Northern Kwa–Zulu Natal. In the first phase, the sample consisted of practices in operating theatres of six hospitals and one regional hospital in area 3 of Kwa–Zulu Natal. The adapted structured checklist based on an established document developed by the MASA Committee for Science and Education (1995) was pilot tested. The collected data was statistically analysed and interpreted with the help of a statistician using SPSS. The results of Phase 1 were used as a base for the Phase 2 questions. Three focus group interviews were conducted with professional nurses who were observed during Phase 1 at the selected hospitals. Findings from quantitative data show that although health care workers take precautions to prevent infections, they do not attain full compliance to universal precautions. The qualitative data indicated that the reasons for non–compliance amongst others were the lack of knowledge of universal precautions, communication factors, resources, including maintenance of equipment, lack of supplies and shortage of human resources and attitudes of health care workers.<br>Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

This study collects the views of 38 health policy leaders, answering one open-ended question in a 1-hour interview: What state-level reforms do you believe are necessary to implement a feasible model of universal health insurance in Oregon? Interviewees represented seven groups: state officials, insurers, purchasers, hospitals, physicians, public interest, and experts. About 370 coded arguments in the interview transcripts were condensed into 95 categorical topics. A code outline was constructed to present a dialogue among stakeholders in one comprehensive narrative. Topical sections include the cost imperative, politics, model systems, insurance, purchasing, delivery system, practice management, and finance. Summary results show the prevalence of group attention to each topic, group affinities, and proximity correlations of different arguments mentioned by individuals. The most common arguments related to problems of low-value care and delivery system reform. There was a generally felt imperative to control costs. Regarding universal health insurance, stakeholders were split between two main alternatives. One model, favored mostly by insurer and purchaser groups, supported the state-sponsored individual mandate. This plan, embodied in the current Oregon Action Plan to implement universal health insurance, involved managed competition for insurers and clinical governance over professional practice. A separate set of arguments, favored mostly by expert and physician groups, emphasized the need for a unified public system, or utility model, possibly with centralized funds and regional global budgets. The ability of the individual mandate plan to control costs or manage quality appears doubtful, which strengthens opposition. The utility model is more likely to work at cost control and governance, but it disrupts the status quo and its details are vague, which strengthens opposition. Neither model is endorsed by a majority of the stakeholders, and political success for either one alone is not promising. Possibly, a close analysis of the two models could find a way to combine them and generate unified support.

<p> The majority of children with exceptionalities aged 3-5 are being served in general education settings. Teachers working in these inclusion classrooms must have the ability and knowledge to work with all students under their care. The purpose of this study was to determine how teachers in early childhood inclusion classrooms plan to incorporate the principles of Universal Design for Learning, an inclusive pedagogy, and to determine how professional development in UDL changes teachers' knowledge and behaviors in the classroom. This qualitative case study followed two early childhood inclusion co-teachers and a district office specialist in charge of the UDL professional development. Interviews, observations, lesson plans, and training materials were collected over an extended amount of time in the field. Results of the data analysis indicated that many principles of UDL were inherent in quality early childhood instruction. Teachers were adept at individualizing instruction on an as needed basis, but they needed more practice at embedding modifications and accommodations into curriculum and instruction. Early childhood teachers understood and saw the value in UDL, but they lacked appropriate professional development, access to the necessary resources, and the time needed to take universal instruction to the next level.</p>

In the Internet information space, advanced information retrieval (IR) methods and automatic text processing are used in conjunction with traditional knowledge organization systems (KOS). New information technology provides a platform for better KOS publishing, exploitation and sharing both for human and machine use. Networked KOS services are now being planned and developed as powerful tools for resource discovery. They will enable automatic contextualisation, interpretation and query matching to different indexing languages. The Semantic Web promises to be an environment in which the quality of semantic relationships in bibliographic classification systems can be fully exploited. Their use in the networked environment is, however, limited by the fact that they are not prepared or made available for advanced machine processing. The UDC was chosen for this research because of its widespread use and its long-term presence in online information retrieval systems. It was also the first system to be used for the automatic classification of Internet resources, and the first to be made available as a classification tool on the Web. The objective of this research is to establish the advantages of using UDC for information retrieval in a networked environment, to highlight the problems of automation and classification exchange, and to offer possible solutions. The first research question was is there enough evidence of the use of classification on the Internet to justify further development with this particular environment in mind? The second question is what are the automation requirements for the full exploitation of UDC and its exchange? The third question is which areas are in need of improvement and what specific recommendations can be made for implementing the UDC in a networked environment? A summary of changes required in the management and development of the UDC to facilitate its full adaptation for future use is drawn from this analysis.

Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, Institute for Data, Systems, and Society, Technology and Policy Program, 2015.<br>Cataloged from PDF version of thesis.<br>Includes bibliographical references (pages 112-122).<br>In 2009, it was estimated that 1.4 billion people in the world lack access to electricity, and approximately 2.7 billion people rely on biomass as their primary cooking fuel. Access to reliable electricity and modem forms of energy for cooking can contribute to improvements in sectors beyond the energy industry such as health, education, commerce, and agriculture, and has been shown to correspond with poverty alleviation and economic growth. A successful strategy towards universal access requires a careful assessment of the diverse energy services needs from the perspective of the beneficiaries, the impact on their economic and social development, and the environmental consequences. This thesis proposes a comprehensive methodology for the assessment of the appropriate modes of electrification and heating and cooking for specific countries or regions. The software tools used for this analysis are incorporated in the proposed technology toolkit consisting of: the Reference Electrification Model (REM)-used to determine the appropriate modes of electrification (grid extension, micro or isolated systems) given the current base scenario; the Reference Cooking Model (RCM)-used to determine technology choices for the provision of modem heat for cooking; and the MASTER4all Model-used to evaluate the future macro level impact of different energy access strategies in a specific region or a country as a whole, taking into account various business scenarios and regulatory policies. While the analytical strategy presented here is intended to be generalizable for other regions, it is based on a case study of Kilifi County in Kenya. The larger goal of this project, through the case study approach, is to provide a proof of concept for the decision support tools being developed that could be used in energy access expansion planning.<br>by Lily Mkanjala Mwalenga.<br>S.M. in Technology and Policy

In 2001, the government of Thailand implemented a universal coverage (UC) policy for access to health care by introducing a tax-funded health insurance scheme, the UC scheme, to approximately 47 million people who were not previous beneficiaries of the Civil Servant Medical Benefit Scheme (CSMBS) or the Social Security Scheme (SSS). The UC policy resulted in a significant change in health care financing arrangements and financial barriers to health services. The purpose of this research was to explore the likely impact of the UC policy in terms of the following factors: changes in health care use, equity in health care finance, and the distribution of public subsidies on health among different socio-economic groups of Thais. In addition, the effectiveness of the UC policy in protecting households against financial hardship as a result of medical care costs was explored at the household level. Benefit incidence analysis (BIA) was employed as a tool to assess equity in health service use and the distribution of public subsidies. Two case studies of renal replacement therapy (RR T) for end-stage renal disease (ESRD) patients and cardiac operations for heart disease patients were employed as tracers to explore the impact of the UC scheme's benefit package for better-off and less well-off households. Different choices of socio-economic group indicators (household income per capita or an asset index) and the use of aggregate and regional unit subsidies to calculate benefit incidence were also applied. Research results indicate that the UC policy did expand health care coverage to include nearly all Thais and increased the pro-poor nature of the Thai health care system, as well as the distribution of public health-related subsidies. Ambulatory service use and hospitalization of poorer quintiles significantly increased after the UC policy was implemented. The poorest quintiles gained the highest amount and proportion of public subsidies both prior to and after implementation of the UC policy. There was no change in conclusions regarding the distribution of public subsidies among different socioeconomic groups when different choices of socio-economic indicators or different levels of government unit subsidies were used. The analysis of financing incidence between 2000 and 2002 also showed less regressive overall health care finance, a greater decrease in household expenditure for health care among poorer quintiles, and a decrease in the catastrophic expenditure incidence in 2002, compared to 2000. The decision to exclude RRT from the UC benefit package resulted in a considerable financial barrier to health services and a substantial economic impact on poorer ESRD patients. Infrequent access to haemodialysis and the inability to obtain essential and expensive medication (erythropoietin) was shown to be a major cause of patients' death. Financial barriers to RR T prevented poorer ESRD patients from benefiting from access to essential health services, and the financial burden of RR T meant all poorer patients were inevitably faced with financial catastrophe as a result. Poorer ESRD patients adopted various financial strategies to cope with high health care expenditures, which impacted not only the ESRD patients themselves, but also other household members and relatives who had to provide supplemental financial support to help cover the costs of RRT. In contrast, neither poorer nor richer heart disease patients under the UC scheme experienced significant payments for the health care costs of open heart surgery due to the effectiveness of the scheme in financial risk protection. During the operation, a few poorer heart disease patients experienced financial burdens for travel costs and food expenditures for their relatives, but they were able to manage this financial burden by using their savings or taking loans, all without a significant financial impact on household living standards. In conclusion, the UC policy does appear to have overall improved equity in health care use and health care finance, and the distribution of public subsidies. Achievements of the UC policy in Thailand were most likely caused by the following three financing strategies: 1) the expansion of public health insurance to nearly universal coverage; 2) the removal of financial barriers to health services; and 3) the promotion of primary care use which is preferentially accessed and utilized by the poor in rural areas.

Since 2010 the Center for Disease Control (CDC) and its Advisory Committee on Immunization Practices (ACIP) have recommended annual influenza vaccinations for all persons aged six months and up (ACIP, 2017). In December of the same year, the Agency of Health and Human Services (AHHS) unveiled Healthy People 2020, a series of health indicators and corresponding 10-year objectives. This newest iteration of the Healthy People program set target influenza vaccination levels for healthy adults 18 and older at 80% (AHHS, 2010). Aside from the inherent health benefits, multiple studies conducted over the past decade suggest there may be significant economic benefits to a highly-vaccinated population. Depending on the effectiveness of seasonal vaccines, the cost of vaccinating a U.S. adult can be outweighed by the health care savings from the resulting reduction in direct and indirect infection treatment costs. As the state of Vermont considers including influenza vaccinations in its state-mandated Vermont Vaccine Purchasing Program (VVPP), it presents a unique opportunity to conduct a state-wide case study on the potential cost-saving implications of a universally available influenza vaccination. This study takes a historical perspective and looks back at Vermont’s influenza cost, usage, and treatment information since the vaccine was recommended in 2010. Using data generated from Vermont’s immunization registry, de-identified claims data, CDC-reported statistics, and numerous published economic studies, this research answers the question: “What societal costs/savings would have been witnessed if the influenza vaccine was included in the VVPP since 2010?” and, more important, what policy changes can be made now to realize savings in the future? Using a dynamic transmission model embedded in cost-benefit analysis, this research concludes that influenza-related savings of 6.2% would have been experienced over the five flu seasons between fall 2010 and summer 2015. Most of the savings are generated by the increased vaccination rate associated with a universal vaccination program. Creation of such a program in the state of Vermont would likely be economically beneficial.

The main purpose of this study was to investigate the development of the problem-solving skills of eleven year olds in a Western Australian Primary school when the teacher and the children were in-role within the drama. The teacher, as teacher in-role, and the students role-played a variety of situations in which effective problem-solving skills were used. As the study progressed the nature of the children's use of symbol and metaphor became an important issue. In the first session the teacher in-role as the Mayor of a small town informed the children in-role as the town council that an alien spacecraft landed in their imaginary town. The children brainstormed ideas about their characters, the town and the situation confronting them. In the second session the teacher in-role as the Mayor read out a letter from the aliens and then introduced a painting to the children, played music and encouraged the children to draw symbols to represent their town to the aliens. The children created a fluid sculpture using these symbols and then reflected and discussed the lesson. Session three focussed on group skills and involved games, discussions and journal reflections about the town's dilemma. The fluid sculpture was developed in session four. The children made final preparations for the alien landing in session five and organised a meeting place, before meeting the teacher in-role as the alien. The in-role teacher observed the participants in drama sessions over a period of five weeks. Data was gathered from the five 45 minute sessions and collected in the form of: audio-taped interviews; work samples- letters, symbols, drawings and a suggestion box; journals; memos - observational notes and ideas and literature related to the data collated from the drama sessions as shown in Table 4.1. This data was recorded onto checklists and coded for analysis. The data was put into categories to see if there was any development in the children’s problem-solving skills. A case study approach was used with an emphasis on 'symbolic interactionism'. The results showed that in-role drama appeared to enhance the development of the problem-solving skills of eleven year old children. The data analysis showed an improvement in conflict resolution, decision-making and making value judgements. The symbolism encouraged the creation of a universal language and helped to develop the children's emotional awareness. Future researchers could look at the effect of in-role drama techniques on emotional awareness, socialisation, critical thinking and empathy.

Un des enjeux sociétal important concerne le vieillissement des personnes en situation de handicap mental. L’allongement de l’espérance de leur vie a pour conséquence que les établissements spécialisés pour l’accueil des personnes âgées (comme les EPHAD) se retrouvent à accueillir des personnes souffrant des maladies du vieillissement (démence par exemple) en plus d’un handicap mental. Se pose alors le problème de l’accès aux soins pour cette population à travers l’usage des dispositifs médicaux adaptés aux caractéristiques des personnes âgées. La présence d’un handicap mental a plusieurs conséquences : difficulté de compréhension des usages des dispositifs médicaux, personnels peu formés aux conséquences de cette handicap). En effet, les dispositifs médicaux sont spécifiques soit pour les situations de handicaps ou soit pour le contexte du vieillissement (avec des normes, des règles de remboursement différents). Que se passe t-il dans le cas d’un dispositif médical qui doit être adapté non seulement aux contraintes dues au vieillissement et à celles dues à un handicap mental ? Nous proposons donc de partir des questions de départ suivantes comme objectif pour ce sujet de thèse : Y a t-il des difficultés d'accès aux soins pour les personnes âgées en situation de handicap? Quels sont les manques exprimés par les usagers eux-mêmes et par les professionnels du sanitaire? Quel Dispositif Médical faudrait-il "améliorer" ou créer pour faciliter l'accès aux soins pour cette population spécifique ?<br>One og the biggest challenge for our societies is the aging of the population. One is getting particularly important : the ageing of people with mental disorder. The increase of their life expectancy has several consequences in their access to care. Establishment which are specialized in the welcolme of elderly people are now welcoming people with mental disorder. The access to care is one of the most problematic aspect in this phenomenum : what medical devices are adapted for this new population ? Indeed, medical devices are adapted either for people with mental disorder, either for elderly people. For people with mental disorder getting older, there is a need to adapt the tools for them, to adapt the way of communicating with them and the way to monitore them. We are trying to propose new solutions to answer all these questions

Between 2000 and 2015 the Millennium Development Goals were the focus of much global attention and activity. They were selected in light of astounding poverty, with over 1 billion people at the time living on less than $1 per day. In a sense the MDGs were morally undeniable. The focus of this study is MDG2, universal primary education. It sets out to establish how and why MDG2 came to be selected. Whilst its selection seems obvious, for years developing countries complained about the short-sightedness of prioritising primary over secondary and tertiary education (Klees 2008). A task force commissioned by the World Bank and UNESCO at the time showed that the Bank’s rate of return analysis on primary education was flawed. It argued that developing countries need highly educated people to be economic and social entrepreneurs, develop good governance, strong institutions and infrastructure. In this way MDG2’s selection is problematic. Using case study method, first the literature is examined. Three hypotheses are generated: one based on a rational synoptic theory, one on critical theory and one on world society theory. A range of data are used to establish findings and test hypotheses. The study then considers implications of the findings for theory and the policy process. The findings show that priorities promoting more equal opportunities, such as MDG2, were gradually preferred. Whereas priorities promoting more equal outcomes, such as elimination of trade barriers, were gradually excluded. The study finds no evidence that the General Assembly ever voted on the list of 8 MDGs. Rather, the MDGs were selected by elite policy actors, addressing multiple interests. The study considers the assertion that marginalization of the poor does not happen because people harbor ill will toward them, rather because “The poor have no friends among the global elite” (Pogge 2011, p. 62).

Syftet med denna kvantitativa studie är att undersöka huruvida det finns skillnader i andelen insatser inom barnavården mellan de svenska kommunerna. Studiens fokus ligger på att analysera kommunernas strukturella förhållanden i förhållande till vilka åtgärder de vidtar i barnavårdsärenden. De empiriska uppgifterna för studien är främst sekundärdata som samlats in från Statistiska centralbyrån och från Socialstyrelsen. Frågeställningarna för studien är ”Skiljer sig kommunerna åt i andelen barnavårdsinsatser och i sådana fall hur?” och "Om det skiljer sig åt mellan kommunerna, har kommunens strukturella förutsättningar en inverkan på andelen barnavårdsinsatser och i sådana fall på vilket sätt?”. Studiens inhämtade data visar att det finns skillnader i andelen insatser i barnavården mellan kommunerna. Vidare visar analyser av data att skillnaderna i andelen insatser är korrelerade, både negativt och positivt till kommunernas strukturella förhållanden. Resultaten visar också att de olika variabelgrupperna av strukturella förhållanden har olika förklaringar till variationen i de åtgärder som vidtagits. Demografi är den enskilt största förklaringen medan ekonomin visar sig vara den minsta mellan grupperna. Den största effekten som kommer av en variabel är kommunens invånares utbildningsnivå. Vidare visar studien på skillnaderna mellan de svenska kommunerna och belyser ojämlikheterna i det svenska välfärdssystemet. Detta trots sina många förordningar för att motverka detta och att vara allmänt känt för att vara i framkant av den universalistiska synpunkten.<br>The aim of this quantitative study is to examine whether there are differences in the quantity of actions taken in child protections services between the swedish municipalities. Moreover the focus of the study is to analyze the municipalities structural conditions in relation to what actions they take in child protection service cases. The empirical data for the study is primarily secondary data collected from the Swedish Central Bureau of Statistics and from the Swedish National Board of Health and Welfare. The questions at issue for the study are “Do the municipalities differ in the proportion of actions taken in child protection services and if so, how?” and “If it differs between the municipalities, do the municipalities’ structural conditions have an impact on the proportion of actions taken in child protection services and if so, in what way? The collected data shows that there are differences in the amount of actions taken in child protection service cases between the municipalities. Furthermore the analyses of that data demonstrates that the differences in the actions taken are correlated, both negatively and positively to the structural conditions of the municipalities. The findings also shows that the different variable groups of structural conditions have different explanatories of the variation in the actions taken. Demography is the single biggest explanatory while economy is shown to be the smallest between the groups. The greatest effect of a single variable is the education level of the municipality’s citizens. Further on the study exposes the differences between the Swedish municipalities and brings light to the inequalities in the Swedish welfare system. This despite its many regulations to decrees it and widely being known for being in the forefront of the universalistic viewpoint.

Background: Despite postpartum depression (PPD) being the most common medical complication surrounding childbirth affecting 10-20% of new mothers, it is often underdiagnosed and undertreated, especially in primary care. Universal screening with a validated tool is recommended for all postpartum women as evidence shows that formal screening is superior to non-formal screening in detecting women with PPD. Unfortunately, most primary care providers do not formally screen. In southern Maricopa, low income minority women were found to have a higher than average prevalence of PPD. Thus, it is important for providers in this area to screen. Purpose: The purpose of this quality improvement project was to determine provider knowledge, practice behaviors, and perceived facilitators and barriers to PPD screening at an urban Federally Qualified Health Center in the Southwestern United States. This needs assessment was then used to make site-specific recommendations for PPD screening to enhance early identification of women with PPD. Design: A quality improvement project using a quantitative descriptive design. A quantitative survey assessed provider knowledge, practice behaviors, perceived barriers, and perceived facilitators regarding PPD screening. Setting: Wesley Health Center, a primary care clinic in Phoenix, Arizona. Participants: Five primary care providers in family practice. Results: Universal screening with validated screening tools was common. More than half of providers (60%) universally screen all postpartum women for depression with a formal screening tool up to one year postpartum. Providers were correctly using validated screening tools for PPD such as the Patient Health Questionnaire-2 (PHQ-2), PHQ-9 and Edinburgh Postnatal Depression Scale (EPDS), but only one provider (20%) was aware that the PHQ-2 and PHQ-9 are validated for that specific purpose. Wesley is already attempting to universally screen for depression with a two-step process using the PHQ-2 and PHQ-9 for all patients, but participants report that support staff sometimes forget to provide patients with the screening tool before the provider visit, patients sometimes decline to be screened, and providers either forget to catch the opportunity or do not have time. Identified facilitators to screening are support staff (80%) and the electronic health record (20%). Conclusion: One major strength of the clinic is that it already has a policy of universally screening for depression that is validated for use for PPD. The findings from the study indicate that this policy is not always followed due to barriers such as lack of time, support staff not providing screening tools before the provider encounter with the patient, and providers forgetting to screen. The screening process could be enhanced by taking the time to ensure that tools are readily accessible, gathering the input from support staff on the barriers they face to screening patients, and utilizing the electronic health record to make the process more automated. Enhancing the policy already in place would be enhancing screening practices for PPD and improve early detection of this condition. Findings will be disseminated via an executive summary and PowerPoint presentation to the staff.

Appropriate housing for the aging American population is a timely topic of research in both housing and gerontology. Universal design is an innovation in housing design that is gaining interest from both industries. This research examines the effectiveness of universal design features that have been identified by experts in the field of aging, housing, and universal design as important to resident and caregiver participants of the ECHO demonstration housing program. A national survey was conducted that included all available current residents of the HUD ECHO houses and their caregivers. The relationships between age, effectiveness of universal design features, health and dependency were investigated. Quantitative results include some confounding relationships, and plausible explanations. A qualitative analysis, based on on-site and telephone interviews, and tape recordings of those interviews with residents and their caregivers, as well as architectural drawings, observation, and photographs of the ECHO houses provided additional details. The qualitative approach indicated that many of the universal design features recommended by the experts consulted satisfactorily met the needs of residents and/or their caregivers. It also revealed, however that some features were not considered important by residents and caregivers, some were not reported as present (when they were documented by the researcher as present), and at least one HUD-specified universal design feature was not provided by ECHO houses. Another aspect of the qualitative perspective addressed the health of the residents. Health characteristics are presented in the context of their effect on dependency. Phase II dependency task information was compared to that reported in phase I, and improvement and decline was noted. Conclusions, and Implications that elaborate on findings, and future research is recommended for taking this research to the next level.<br>Ph. D.

Bibliography: leaves 62-64.<br>The telecommunications industry was long regarded to be one of "natural monopoly". Technological development has, however, changed the situation in the industry fundamentally: with the introduction of digital wireless telephony (also called "GSM " or "second generation (2G)), competition could effectively be introduced into the industry, as the new networks rely on antennas instead of fixed cable networks. This made it possible, and in the presence of large numbers of subscribers necessary, to build multiple mobile telephone networks in one country.

This dissertation consists of two empirical papers and one methods paper. The first two papers use quasi-experimental methods to evaluate the impact of universal health insurance reform in Massachusetts (MA) and Thailand and the third paper evaluates the validity of a quasi-experimental method used in comparative effectiveness research (CER).

Externalizing behavior problems such as noncompliance, tantrums, and aggression constitutes the most frequently cited reason for referral of young children to mental health clinics. The treatment for conduct problems (CP) that possesses the greatest amount of empirical support is referred to as behavioral parent training (BPT). Yet available data suggest that after accounting for treatment failures and dropouts, only about one third of children receiving BPT benefit significantly. More recently, there has been a shift towards the development of early intervention and prevention models for treating children at-risk for developing CP. While many of these programs have been shown to be effective, they fail to address shortcomings of BPT such as the length of treatment and the context of service delivery. Furthermore, the majority of these programs continue to be classified as selective or indicated prevention programs, thereby targeting children once they have already begun showing elevated levels of disruptive behaviors. More recently, a preventative and abbreviated version of BPT, called preventative behavioral parent training (PBPT), has been developed to address the limitations inherent in BPT. A recent evaluation of PBPT has demonstrated its utility in reducing rates of noncompliance and tantruming in children at-risk for developing CP. This study sought to add to previous findings regarding PBPT by evaluating its effectiveness when disseminated as a universal prevention program within a primary care setting. More specifically, this study aimed to evaluate whether PBPT could be utilized to support parents in learning effective strategies for managing their young child's typical misbehaviors, thereby preventing the development of clinical levels of CP and strengthening the practices of all parents. Results demonstrated that PBPT yielded positive outcomes in regards to both child and parent outcome variables. Furthermore, program evaluation data revealed that the PBPT program was socially acceptable and the strategies discussed were both feasible and effective. Taken together, the current study provides preliminary evidence of the positive proximal impact of the PBPT program. Potential clinical implications of these findings and future directions for research are discussed.

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</meta> </meta> </meta> </meta> </p> <p class="MsoNormal"><span style="font-size: 12pt<br>line-height: 115%<br>font-family: &quot<br>Times New Roman&quot<br>,&quot<br>serif&quot<br>">This study has reveled the levels of knowledge and compliance towards Universal Precautions and examined the factors that are influential in having a positive and negative effect on their adoption by healthcare practitioners in practice. Despite acceptable knowledge regarding the potential for infection and mechanisms to prevent these infections, this study has found out that health care workers are not as compliant with universal precautions as they need to be. The findings that compliance correlated directly with knowledge, with in-service training and with availability of protective equipment, provide important indications for future interventions. Therefore a regular on job refreshing training program on Universal Precautions, a written guideline and reminder poster on Universal Precautions and personal protective equipment need to be made available for all health care providers in every department of the hospital for better compliance. <span style="">&nbsp<br></span><span style="">&nbsp<br></span><span style="">&nbsp<br></span><o:p></o:p></span></p> <p>&nbsp<br></p>

In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.<br>In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.

Cette thèse de doctorat a pour objet d’évaluer les effets potentiels d’une concurrence accrue sur le marché de la santé. Elle porte une attention particulière aux effets de la concurrence sur l’efficacité allocative du système de santé en termes de soins et de dépenses de santé. Dans leur ensemble, nos résultats suggèrent que les effets canoniques de la concurrence ne s’appliquent pas nécessairement au marché de la santé, et détaillent des circonstances dans lesquelles une hausse de la concurrence pourrait nuire au bien-être social. Cette thèse comporte une introduction et trois chapitres (articles académiques), chacun portant sur un aspect diffèrent de l’efficacité du système de santé. Le premier chapitre analyse l’impact de la concurrence sur les pratiques de soins hospitaliers et leur régulation par tarification prospective. Le second chapitre détaille les enjeux de régulation liés à la nature incomplète de l’information sur les patients au moment de choisir la procédure de soins à adopter, à commencer par la décision de mettre en œuvre des tests de diagnostic supplémentaires. Le dernier chapitre de cette thèse discute les conséquences possibles de l’asymétrie qui peut exister entre fournisseur de soins public et privé en termes d’obligation de couverture et pouvant être appliqué au marché de l’aide à domicile des personnes âgées<br>The purpose of this thesis is to study the potential effects of an increased competition between health-care providers on the allocative efficiency of the health-care system. In a theoretical framework it discusses the effect of competitive pressure considering the decentralization of treatment decisions, diagnostic tests’ performance, and the organization of care coverage. It is composed of an introduction and three chapters (essays), each of them focusingon a different aspect of the health-care system efficiency. Our findings globally suggest that the canonical effect of competition does not necessarily applies to the health-care market,and detail circumstances in which competition could degrade social welfare. The first chapter analyses the impact of competition on hospitals’ treatment praxis and their regulation through fixed-repayments. The second chapter details the regulation issues related to the incomplete nature of the information on patients’ illness before the decision to perform diagnostic tests.The last chapter of this thesis discusses the possible outcomes of the asymmetry of obligation of services between public and private competitors in an application to the home-care market for the elderly

Thesis (M.A.)--West Virginia University, 1998.<br>Title from document title page. Document formatted into pages; contains iii, 68 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 64-68).

This study explored the policy implementation paradox. That is, the view endorsed by policy literature that although tremendous investment is made in making policies, change agents and implementers often pursue different agendas when it comes to implementation. The study explored this policy phenomenon using the Free Compulsory Universal Basic Education (fCUBE) policy in Ghana as an exemplar and with a view to investigating the extent to which the 'free', 'compulsory', 'universal' and 'basic education' provisions, claimed in the policy documents, are reflected in its implementation process. The research aimed to find out how the conception and articulation of the policy purposes encapsulated in official documentation impacted on the implementation process. This approach involved the critical discourse analysis of a range of publicly available documentation and the analysis of interviews with eleven elite individuals and five groups of policy mediators at the meso-level of the Ghanaian educational system. The study posits that, owing to its commitment to the ideals of social justice, the 'fCUBE' policy is seen as deeply rooted in social democracy. However, the advent of neo-liberal ideological discourse on education wrapped in the rhetoric of 'skills for knowledge-based economy' has triggered the neutralization of progressive undercurrents, resulting in a significant discursive shift in language and policy direction. As such, it is contended that as long as there are private costs to education vis-a-vis disparities in educational provision and delivery, the 'free', 'compulsory', 'universal' and 'basic education' components of 'fCUBE' cannot be said to be adequately reflected in the implementation process. It is concluded that the policy implementation paradox is a natural policy phenomenon occurring as a result of the moving discursive shifts that occur as policy is enacted, and that this needs to be acknowledged and concerted efforts made to effectively manage its effects on policy processes.

Thesis (DTech(Design)--Cape Peninsula University of Technology, 2009<br>Universal Design (UD), as it is known in the USA and elsewhere, is an inclusive approach to designing for the broader population and is rapidly gaining popularity amongst design practitioners and planners globally. Similar non-exclusive approaches have evolved in diverse parts of the world to counter the systemic disablement and exclusion of vulnerable/special populations of users perpetuated by traditional approaches to design. The transdisciplinary field of UD is informed by concilience in accommodating a wide range of related fields, such as education, landscape architecture, architecture, town and regional planning, industrial/product/three-dimensional design, furniture design, interior design, communication/information/graphic design, interaction design, human-computer interaction (HCI)/usability studies, and ergonomics/human factors engineering. UD proposes a collaborative systems approach that benefits from the synergies of cross-functionalism by approaching the diverse challenges facing society through socially responsible design. In so doing, UD can potentially impact such diverse issues as health, transportation, inclusive education, sports and recreation, entertainment, social welfare, inclusive employment, transgenerational/lifespan housing, inclusive tourism, accessibility, safety, and ecological concerns on sustainability.

Since its inception in 2002, Sarva Shiksha Abhiyan (SSA) has achieved only limited success in implementing its goals, especially in rural sections of India. There appears little basic awareness of the policy, not only among the members of the community but those involved in local administration and the teachers employed under SSA. With SSA's mandate for community involvement in policy implementation, the purpose of this research is to seek to understand if and how community involvement is effective in the local-level educational leadership and, if so, how it helps in the process of implementing SSA to ensure greater success in access and quality of education. The research utilises a qualitative case study methodology to gather in-depth data from local-level educational leaders within SSA's management structure in two rural villages in Odisha. Documents were analysed and used as supportive evidence to the data. The analysis of both case studies generated three major themes: management structure that does not foster effective community participation; dominance, both institutional and social, that leaves little scope for inclusion of the marginalised in the implementation process; and how support from the government and policy-makers that is made available to the community is insufficient in terms of resources and accountability procedures. The study makes recommendations to: policy-makers to make changes in the way policies should be contextualised in their time frames and promoted; policy evaluators, government planners and those issuing checks and controls at the local level to strengthen the implementation process and work out better ways of involving communities to be part of the local-level leadership within the implementation process; and community members, especially the marginalised, so they have the chance to reflect and express their honest opinions. The process enables them to understand the legalities of their position and the responsibilities that were being ignored because of their tokenistic position. The thesis makes suggestions to empower both people and systems.

“We emphasize the need to address the challenge of access to sustainable modern energy services for all, in particular for the poor, who are unable to afford these services even when they are available.”  Section 126: The Future We Want (Out Come Document of Rio+20-United Nations Conference on Sustainable Development June 20-22, 2012). The lack of energy access has been identified as a hurdle in achieving the United Nations’ Millennium Development Goals, leading towards the urge to set a goal for universal electrification till 2030. With around 600 million people in Africa without access to electricity, effective and efficient electrification programs and policy framework is required to achieve this goal sustainably. South Africa is an example in the continent for initiating intense electrification programs and policies like “Free Basic Electricity”, increasing its electrification rate from 30% in 1993 to 75% in 2010 and a claimed 82% in 2011. The case of South Africa has been analysed from the perspective of universal electrification in the coming years. The aim was to estimate the un-electrified households for each area of South Africa in order to provide the basis for electrification planning. The idea was to use available electrification statistics with GIS (Geographic Information System) maps for grid lines and identifying the suitability of on-grid or off-grid electrification options, which may help in planning the electrification of these areas in the near future. However, due to lack of readily available data, the present work has been able to estimate the un-electrified households &amp; their possible electrical load. The estimates have been distributed in different income groups for each province and district municipality of South Africa, which can be used for electrification planning at national, provincial and municipal level.  As a result, some simple and useful data parameters have been identified and an estimation methodology has been developed, which may be employed to obtain similar estimates at lower administrative levels i.e. local municipalities and wards. The work can be utilized further and feasible electrification options may be suggested for different areas of South Africa, with the help of GIS maps and data. Depending on the availability of useful data, the data parameters &amp; indicators used in this work will be helpful for planning the electrification for rural households in other places of Africa.

Made available in DSpace on 2014-07-29T15:04:35Z (GMT). No. of bitstreams: 1 Keyti Cristine Alves Damas Rezende.pdf: 1269546 bytes, checksum: b946d7bf22d7590bcb5094c9cefe91d0 (MD5) Previous issue date: 2011-03-30<br>Infections in health care services, among which include primary care, have represented a serious problem and with several repercussions in the context of human health. The activities conducted in primary care are potential source of biological risk, both for users of these services and for their workers. Thus, this study aimed to analyze the biological risk for professionals and users during the execution of procedures in the Health Units in the catchment area of a Health District of Goiânia - GO. This is a descriptive, exploratory and cross-sectional study with quantitative approach. Data collection occurred among January and May of 2010, through direct not participant observation, being the data recorded in specific check list for each procedure. A questionnaire, with closed and open questions, was used to characterize the professional involved in the procedure followed and their qualification for the job. The data were processed using SPSS (Statistical Package for Social Sciences) version 16.0 for Windows and, then grouped in tables and figures. There were around 280 hours of observation, a total of 149 procedures, being 77 vaccinations, 28 bandages, 24 vaginal smears, 11 neonatal screening and 9 Mommy test. The procedures were performed by 28 professionals, 5 (17.8%) were nurses and 23 (82.1%) were nursing technicians, most females (95.3%).The results showed the possibility of exposure to biological material, because, in these procedures there is handling is sharp, the possibility of contact with blood, secretions, and immunobiological, aerosol formation, the proximity of the face and punched a member of the professional, agitation and/or reaction unexpected user. We found that there is poor adhesion to Hand Hygiene - HH and on the use of Personal Protective Equipment - PPE. The low rates of HH, in addition to non-adhesion to proper technique form a risk behavior that endangers health professionals and users. Failures related to the availability of PPE in the services studies here can influence the low adhesion to them and enable greater exposure to biological risk. Educational and management actions, aimed at consolidating a practical aware of the potential biological relevance and the availability of resources, are necessary for a greater adherence to this Standard Precautions. The nurse, as leader of this team, should be encouraged to develop actions based for security and commitment to minimize the risk inherent in biological practice, still working with educational activities. We point out the need for infection control committees to act in several health districts, directing and supervising the use and provision of these resources. More studies should be done in this area so that a deeper understanding of the topic, seeking alternative solutions to the specific and primary care.<br>As infecções nos serviços de assistência à saúde, dentre os quais se incluem os da atenção básica, têm representado um problema grave e de repercussões diversas no contexto da saúde humana. As atividades desenvolvidas na atenção básica são, potencialmente, geradoras do risco biológico, tanto para os usuários desses serviços quanto para os seus trabalhadores. Diante disso, este estudo teve como objetivo geral, analisar o risco biológico para profissionais e usuários durante a realização de procedimentos nas Unidades de Saúde, na área de abrangência de um Distrito Sanitário da cidade de Goiânia GO. Trata-se de um estudo do tipo descritivo, exploratório e transversal, com abordagem quantitativa. A coleta de dados ocorreu no período de janeiro a maio do ano de 2010, por meio de observação direta, não participante e as informações registradas em check list específico a cada procedimento. Um questionário, com questões fechadas e abertas, foi utilizado para caracterização do profissional envolvido no procedimento observado e sua qualificação para o trabalho. A análise dos dados ocorreu por meio de estatística descritiva, utilizando freqüência simples e esses foram apresentados em forma de tabelas e figuras. Os procedimentos observados foram teste do pezinho, teste da mamãe, exame colpocitológico, vacinação e curativos. Foram realizadas 149 observações, sendo referentes a 77 vacinações, 28 curativos, 24 exames colpocitológicos, 11 testes do pezinho e nove testes da mamãe. Durante o estudo, foram realizadas 280 horas de observação a um total de 149 procedimentos realizados por 28 profissionais. Desses, 18,8% eram enfermeiros e 81,2% eram técnicos em enfermagem e o sexo feminino foi predominante (95,3%). Os resultados mostraram a ocorrência de exposição ao risco biológico, pois, nesses procedimentos, há manuseio de perfurocortantes, possibilidade de contato com sangue, secreções e imunobiológicos, de formação de aerossóis, proximidade entre membro puncionado e a face do profissional, agitação e/ou reação inesperada do usuário. Verifica-se que há adesão insatisfatória à Higiene de Mãos - HM e ao uso de Equipamentos de Proteção Individual - EPI. Os baixos índices de HM, somados a não adesão à técnica correta compõem um comportamento de risco que pode afetar profissionais e usuários. Falhas relativas à disponibilidade dos EPI, nos serviços integrantes do estudo, podem influenciar a baixa adesão aos mesmos e possibilitam uma maior exposição ao risco biológico. Acredita-se que ações educativas, voltadas à consolidação de uma prática profissional, consciente do risco biológico, são necessárias para que ocorra uma maior adesão a essas Precauções Padrão. O enfermeiro, como líder dessa equipe, deve ser estimulado a desenvolver ações pautadas na segurança e compromisso de minimizar o risco biológico inerente à sua prática, atuando ainda com ações educativas. Aponta-se a necessidade de comissões de controle de infecção para atuar nos diversos distritos sanitários, orientando e supervisionando o uso e a provisão desses recursos. Mais estudos devem ser feitos nessa área para que ocorra um maior aprofundamento do tema, buscando alternativas e soluções às especificidades presentes.

Mestrado em Desenvolvimento e Cooperação Internacional<br>A dissertação analisa o sistema de saúde cabo-verdiano, com o objetivo de compreender o seu modelo de financiamento atual. Começa por fazer uma revisão da literatura teórica sobre sistemas de saúde, financiamento e cobertura universal dos cuidados de saúde, enquanto suporte para o desenvolvimento analítico do tema. A seguir, introduz um conjunto de informações sobre o caso de Cabo Verde, como a evolução dos indicadores de saúde e a organização do Serviço Nacional de Saúde. Com base nos elementos anteriormente tratados e numa leitura comparada de experiências de outros países insulares, a dissertação procura responder a questões como a organização do financiamento da saúde em Cabo Verde e seus componentes, a capacidade de mobilização de fundos financeiros e a situação da cobertura universal dos cuidados de saúde, indispensáveis para uma melhor avaliação do modelo de financiamento.<br>The dissertation analyzes Cape Verde health system, in order to understand its current financing model. We will begin with a literature review on the health system theoretical work and on the financing and universal coverage of health care, as a support for the analytical development of the subject. Next, we will introduce a set of information about the Cape Verde case, such as the analysis of the socioeconomic situation, the evolution of the health indicators and the organization of the Nacional Health Service. Based on the previously discussed elements and on a comparative reading of experiences from other island countries, this dissertation seeks to answer questions such as the organization of health financing in Cape Verde and its components, the capacity to mobilize financial funds and the situation of universal coverage health care, essential for a better assessment of the funding model.<br>info:eu-repo/semantics/publishedVersion

Philosophiae Doctor - PhD<br>South Africa has not responded well to recommendations in national evaluation reports to address human resource challenges associated with the implementation of nutrition programmes and improved service delivery. Twenty-four years have passed since the dawning of democracy and the nutrition situation within the population has actually deteriorated, with persistently high levels of stunting in young children and the growing prevalence of overweight and obesity in all age groups. These conditions not only rob people of their potential, but they carry a high cost for the state and society as a whole. This study aimed to develop a comprehensive and empirically sound nutrition workforce development planning framework for the public health sector so that it is better equipped to address the nutrition-related burden of disease in South Africa. The study explored the provision of nutrition services in South Africa, focusing on the nutrition-specific work components of health personnel ‒ doctors, nurses, dietitians, nutritionists, health promoters and community health workers working at the primary health care level in the public health sector. Evidence-based workforce information was collected through a mixed methodology comprising: literature reviews, document reviews, analysis of scopes of practice, job descriptions, competencies, workforce surveys, key informant interviews and consensus assessments through the application of the Delphi technique. Permission was obtained to adapt and use questionnaires from an Australian workforce study. Ethical approval, permission to conduct the study and informed consent were obtained prior to the commencement of the interviews. Data was then analysed using descriptive statistics, content and thematic analysis and triangulation of all findings, followed by consensus assessments to describe the nutrition workforce and delineate the roles and functions thereof. The comprehensive planning framework that was developed was applied to the Western Cape province.